HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Aronson, S. Articles by Karp, R. B. Search for Related Content PubMed PubMed Citation Articles by Aronson, S. Articles by Karp, R. B.

The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 214-221, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Myocardial distribution of cardioplegic solution after retrograde delivery in patients undergoing cardiac surgical procedures

S Aronson, BK Lee, JG Zaroff, JG Wiencek, R Walker, S Feinstein and RB Karp
Department of Anesthesia and Critical Care, University of Chicago, IL 60637.

The myocardial distribution of both antegrade and retrograde cardioplegia for cardiac surgical intervention, after induction of cardioplegia via the aortic root, was directly assessed and compared in 19 patients by means of contrast echocardiography. Two-dimensional transesophageal echocardiographic images of the short axis of the left ventricle at the level of the papillary muscles were obtained after sonicated Renografin-76 microbubbles were injected into an aortic root and/or transatrial coronary sinus catheter during delivery of cardioplegic solution. Segmental distribution of cardioplegic solution was immediately noted in the myocardium at the time of contrast injections. In 11 of 18 patients (61%) cardioplegic solution was dispersed to all left ventricular myocardial segments after antegrade delivery. In 17 of 19 patients (90%) retrogradely delivered cardioplegic solution (after antegrade induction of cardioplegia in 18 of the 19 patients) was dispersed to all the left ventricular myocardial segments, including the septum. In 2 of the patients, initial lack of retrograde distribution of cardioplegic solution was remedied when the coronary sinus catheter was repositioned and contrast cardioplegic solution was reinjected. Imaging of the right ventricle was possible in only 4 of the 19 patients and revealed that after retrograde delivery, cardioplegic solution had been at least partially distributed to the right ventricle as well. We performed off-line videodensitometric analysis in 9 patients after retrograde delivery of cardioplegic solution. Mean peak pixel-intensity ratio of flow from the endocardium to the epicardium in the left ventricular free wall was 1.46 +/- 0.27, and mean peak pixel-intensity ratio of flow from the left to the right intraventricular septal endocardium was 1.39 +/- 0.33 (p < or = 0.05).

This article has been cited by other articles:

				F. Onorati, A. Renzulli, M. De Feo, G. Santarpino, R. Gregorio, A. Biondi, F. Cerasuolo, and M. Cotrufo Does antegrade blood cardioplegia alone provide adequate myocardial protection in patients with left main stem disease? J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1345 - 1351. [Abstract] [Full Text] [PDF]

				G. Tian, B. Xiang, G. Dai, G. Li, J. Sun, R. Summers, and R. Deslauriers Retrograde cardioplegia J. Thorac. Cardiovasc. Surg., April 1, 2003; 125(4): 872 - 880. [Abstract] [Full Text] [PDF]

				M. G. Licina, R. M. Savage, C. Hearn, and E. J. Kraenzler The Role of Transesophageal Echocardiography in Perfusion Management Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 2001; 5(4): 321 - 334. [Abstract] [PDF]

				P. Kulshrestha, J. A. Rousou, R. M. Engelman, J. E. Flack III, D. W. Deaton, R. B. Wait, and H. M. Hampf Does warm blood retrograde cardioplegia preserve right ventricular function? Ann. Thorac. Surg., November 1, 2001; 72(5): 1572 - 1575. [Abstract] [Full Text] [PDF]

				P. F.A. Bakker, F. de Lange, R. N.W. Hauer, R. Derksen, and J. M.T. de Bakker Sequential map-guided endocardial resection for ventricular tachycardia improves outcome Eur. J. Cardiothorac. Surg., April 1, 2001; 19(4): 448 - 454. [Abstract] [Full Text] [PDF]

				F. F. Immer, A. M. Seiler, B. C. Aeschbacher, F. Mahler, H. Saner, and H. Saner Influence of the Ultrasound Contrast Agent Levovist(R) on Human Nailfold Capillary Microcirculation Angiology, February 1, 2000; 51(2): 123 - 129. [Abstract] [PDF]

				S. Aronson Cardioplegia delivery: more (or less) than what you see Ann. Thorac. Surg., September 1, 1999; 68(3): 797 - 798. [Full Text] [PDF]

				M. A. Borger, K. S. Wei, R. D. Weisel, J. S. Ikonomidis, V. Rao, G. Cohen, T. Shirai, A. S. Omran, S. C. Siu, and H. Rakowski Myocardial perfusion during warm antegrade and retrograde cardioplegia: a contrast echo study Ann. Thorac. Surg., September 1, 1999; 68(3): 955 - 961. [Abstract] [Full Text] [PDF]

				S. Aronson Myocardial Contrast Echocardiography: Is it Ready to be Used as a Clinical Tool in the Operating Room? Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 1997; 1(1): 4 - 15. [PDF]

				Q. Caretta, P. Voci, M. C. Acconcia, and F. Chiarotti COLLATERAL FLOW PREVENTS UNINTENTIONAL MYOCARDIAL ISCHEMIA DURING ANTEGRADE CARDIOPLEGIA IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING J. Thorac. Cardiovasc. Surg., March 1, 1997; 113(3): 585 - 593. [Abstract] [Full Text]

				L. L. Mickleborough, H. Maruyama, Y. Takagi, S. Mohamed, Z. Sun, and L. Ebisuzaki Results of Revascularization in Patients With Severe Left Ventricular Dysfunction Circulation, November 1, 1995; 92(9): 73 - 79. [Abstract] [Full Text]

				A. Ardehali, H. Laks, D. C. Drinkwater Jr, R. N. Gates, and E. Kaczer Ventricular Effluent of Retrograde Cardioplegia in Human Hearts Has Traversed Capillary Beds Ann. Thorac. Surg., July 1, 1995; 60(1): 78 - 82. [Abstract] [Full Text]

				B. S. Allen, J. W. Winkelmann, H. Hanafy, R. S. Hartz, K. S. Bolling, J. Ham, and S. Feinstein Retrograde cardioplegia does not adequately perfuse the right ventricle J. Thorac. Cardiovasc. Surg., June 1, 1995; 109(6): 1116 - 1126. [Abstract] [Full Text]

				C. Quintilio, P. Voci, F. Bilotta, G. Luzi, F. Chiarotti, M. C. Acconcia, C. Mercanti, and B. Marino Risk factors of incomplete distribution of cardioplegic solution during coronary artery grafting J. Thorac. Cardiovasc. Surg., March 1, 1995; 109(3): 439 - 447. [Abstract] [Full Text]

				M. Carrier, J. Gregoire, A. Khalil, P. Thai, J.-G. Latour, and L. C. Pelletier Myocardial distribution of retrograde cardioplegic solution assessed by myocardial thallium 201 uptake J. Thorac. Cardiovasc. Surg., December 1, 1994; 108(6): 1115 - 1118. [Abstract] [Full Text]

				J. S. Ikonomidis, T. M. Yau, R. D. Weisel, N. Hayashida, X. Fu, M. Komeda, J. Ivanov, S. Carson, M. K. Mohabeer, L. Tumiati, et al. Optimal flow rates for retrograde warm cardioplegia J. Thorac. Cardiovasc. Surg., February 1, 1994; 107(2): 510 - 519. [Abstract] [Full Text]